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The Dear Baby Project: An Interactive Journaling Tool for Pregnancy Education

Emily Danforth

A Project presented to the faculty of The University of North Carolina at Chapel Hill

in fulfillment of the requirements for Undergraduate Honors

Date Completed: April 11, 2014

Honors Advisor Approval: ___________________________ Honors Advisor

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Abstract

A wide body of literature indicates that pregnancy and childbirth education is often inaccessible and that it inadequately addresses psychological aspects of pregnancy. This paper reviews the numerous barriers to providing useful prenatal education and outlines the ideal approach to prenatal teaching. Then, the author presents the concept for new tool for interactive pregnancy education, The Dear Baby Project. The Dear Baby Project is a self-contained kit that involves the cognitive, physical, and affective aspects of pregnancy and delivers health information while leading women to create a scrapbook and journal of their pregnancy. The Dear Baby Project capitalizes on the known benefits of reflection and journaling to provide a fun approach to pregnancy and parenting education. The exercises contained in the Dear Baby Project guide women through important learning topics and promote a feeling of mental and emotional readiness. The Dear Baby Project is meant to address six educational units and this paper presents the pilot materials for one of those units: emotions and emotional aspects of pregnancy and parenting. With careful attention to readability, appropriateness and suitability of materials, the author provides examples of educational, art, and literary components from the kit. The flexibility of this design will allow clinicians to select relevant modules and distribute kits that are tailored to each patient’s individual risks, needs, interests, and expectations. The final portion of this paper describes the next steps in the project’s design and implementation and proposes some innovative modifications for the project content.

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The Dear Baby Project: An Interactive Tool for Pregnancy Education

Pregnancy is a time of excitement, change, and numerous learning needs. Expectant women experience the physiological changes of pregnancy and childbirth and must navigate a significant psychological transition as well. The work presented here details a tool, called the Dear Baby Project, that is designed to educate pregnant women while allowing them to engage in reflection, creativity, and thoughtful consideration of their pregnancy and future lives as mothers.

The Dear Baby Project is a self-contained arts and journaling kit complete with instructions, information fact sheets, crafting activities, supplies, and a binder to house the completed work. It consists of information and activities related to six general topics: the

development of the baby, emotional and relationship changes during pregnancy and beyond, the health and well-being of the mother, labor and delivery, caring for the baby, and emergencies or when/who to contact if something goes wrong. For each of the six broad topics, the kit contains modules with easy-to-understand information fact sheets, art projects, and literary/journaling exercises. In completing the Dear Baby Project kit, mothers will not only have reviewed useful health information but will also have chronicled their pregnancy and created a specialized scrapbook of their experience.

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completed activities. The final sections of the paper lay out the next steps for the project, including suggestions for adaptation.

Literature Review

Pregnancy is a developmental period where patient education is critical and where

psychosocial well-being is a key component to a successful developmental transition. How many women actually receive this important preparation before the birth of their baby? How do most women and their families get their information and are they satisfied with that preparation? Gager, McLanahan, and Glei (2002) analyzed data from the 1996 Commonwealth Fund Survey of Families with Young Children and found that only 40 percent of parents felt confident about their abilities to parent and believed that they were coping well with the demands of new parenthood. Though dated, the statistic is unsettling. More recent research indicates that the health information, particularly the psychological preparation mothers receive in childbirth classes continues to be unsatisfactory. Prenatal education tends to focus physical needs and leaves significant gaps in provision of education regarding mental health issues, family life/sexuality, and parenting (Hanson, VandeVusse, Roberts, & Forristal, 2009).

In 2007, 70.5% of pregnant women in the United States received early and adequate prenatal care according to the U.S. Department of Health and Human Services (2013). While we might expect that women will receive education and information about their pregnancy during their prenatal visits, the actual clinical tasks tend to focus on immediate health issues and women are referred to attend childbirth classes separately (Novick, 2009). In the United States,

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Pregnant women make up a large patient population of relatively healthy individuals with a strong readiness to learn. Taken together, the literature reviewed above indicates a definite need for enhanced prenatal education, particularly tools targeting the development of

psychological and other coping skills. Common Barriers to Prenatal Education

While there is little research on prenatal education effectiveness rates, there is ample research on the common barriers to accessing and receiving prenatal education. Common reasons why women do not attend childbirth classes or receive effective prenatal and parenting education include:

• Low average level of patient literacy and lack of informational materials written in

simple, easy-to-understand language (Hansford & Forsdike, 2013; Porter et al., 2012; Renkert & Nutbeam, 2001; Shieh & Hosei, 2008);

• Feeling confident enough without the classes or having attended classes for a

previous birth (Murphy-Black, 1993).

• Difficulty finding time to fit the classes into their schedule and/or needing to find

childcare in order to attend any additional classes or events (Murphy-Black, 1993; Novick, 2009);

• Financial costs (Murphy-Black, 1993; Novick, 2009; Phillippi & Roman, 2013); • A lack of culturally appropriate options (Nolan, 2005);

• A fear of being judged and a fear of being pressured to participate in specific prenatal

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• Concern for being made to feel guilty about risky behaviors the mother has engaged

in (e.g. drug or alcohol use) (Phillippi & Roman, 2013; Roberts & Pies, 2011; Tighe, 2010);

• Worries that someone will contact Child Protective Services (Roberts & Pies, 2011).

Best Practices In Prenatal Education

Given the numerous barriers to accessing and understanding prenatal education, what can be done? What would an ideal prenatal education program look like? Most pregnant women are adults who appreciate and learn best when approached using the principles of adult learning

(Nolan,  2005;  Nolan  &  Foster,  2005;  Tighe,  2010). Based on those principles, childbirth and

parenting education should be client-led and dynamic. Women and their partners want to see themselves engaged in their own personal gain (Nolan,  2005). Education should draw on previous life experience, link experiences to the new learning, and should encourage clients to reflect on the influences their parents and family lifestyles have had on their beliefs and

behaviors (Nolan,  2005;  Nolan  &  Foster,  2005). Ideal prenatal education would be casual and fun, offered early on with continuity throughout pregnancy, accommodate all social backgrounds, include flexibility on the topics covered, be conducted in a comfortable setting, and tailored toward each individual woman and her family (Candib, 2010; Tighe, 2010). The information should be free or inexpensive.

Description Of The Product

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Perry, Thurston, & Osborn, 2008; Staricoff, 2006) as means of health promotion (Mills, Knuiman, Rosenberg, Wood, & Ferguson, 2013). The method allows women to work on the project at their own pace, in the comfort of their own familiar home or space, and using their own personal experiences as inspiration.

The Dear Baby Project is a self-contained kit for pregnant women. Health care providers may distribute the kits at the first prenatal visits, or women may request a kit on their own behalf. Women will use the kit to complete self-directed modules that each have three components: an educational fact sheet, an arts and crafts activity, and a related literary or journaling activity. The kit will contain everything the women need to complete each of the modules: instructions, examples, craft supplies, and some journaling stationary. In addition to each of the educational modules and their accompanying activities, the kit encourages women to write letters to their babies throughout their pregnancies. All of the letters, journaling, art activities, and educational handouts may be housed in a decorated three-ring binder that comes in the kit. By the end of the pregnancy, the woman will have a chronicle of her pregnancy with art activities, poems and other things she has created. This will serve as both a meaningful way for her to reflect on pregnancy and her transition to parenthood as well as a lovely keepsake to pass on to the baby when he or she is older. While some parents forgo prenatal education classes because they have been for a previous pregnancy, the Dear Baby Project offers an experience that parents can enjoy for each pregnancy, even including their existing children in its creation.

Target Audience

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modules are written in English only. Ideally the modules will be available in different languages, with an adaptable set of culturally relevant modules.

When To Implement The Product

Providers should distribute the Dear Baby Project kit early on at one of the first prenatal visits. Women will then maximize their time journaling and will be able to work through project modules that are appropriate for their stage in the pregnancy. Qualitative studies indicate that nurses should help women develop coping skills early on in pregnancy (Côté-­‐Arsenault,  2007;   Perry,  Thurston,  &  Osborn,  2008). Through providing education early, nurses enable women

to develop those problem-focused coping skills. Expected Outcomes

Women should learn about their pregnancy, birth, and the transition to parenthood while developing a sense that they have the ability to successfully give birth and parent their child. They should feel more confident in their knowledge and ability and recognize that they can make their own decisions. One of the main goals for the Dear Baby Project is to increase expecting women and their partners’ psychological skills and coping mechanisms.

In addition to benefiting women and their families, the Dear Baby Project will aid clinicians. Healthcare providers can use the Dear Baby Project as a means to encouraging patients’ self-directed preparation. Providers can also utilize the product as a way for patients to keep track of important information. For example, practitioners may want a mother with

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Topics Covered

Extensive literature review reveals that prenatal information from practitioners, books, and birth/parenting classes falls into six broad categories (Billingham, 2011; Hanson,

VandeVusse, Roberts, & Forristal, 2009; Nolan, 2005; Novick, 2009):

• The development of the baby

• Emotional and relationship changes during pregnancy and early parenthood • The health and well-being of the mother

• Labor and delivery • Caring for the baby

• Emergencies or when/who to contact if something goes wrong

Eventually, The Dear Baby Project will include multiple modules for each of those six units. To limit the scope of the work presented here, this paper presents pilot materials for only one of the six units.

Research on parents’ and caregivers’ perspectives show parents are most interested in developmental information about their babies, practical skills, and information that is

timely/appropriate for their stage in the pregnancy and birth (Billingham, 2011; Candib, 2010; Hanson, VandeVusse, Roberts, & Forristal, 2009; Nolan, 2005; Tighe, 2010).

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Practitioners may inadequately address this subject in order to prioritize immediate physiologic concerns.

In a longitudinal study of women’s health during pregnancy and the first six months postpartum, Tulman and Fawcett (2003) asked women to reflect about their pregnancy and their postpartum life. 52% of the women in the study said that they felt the first six months postpartum were harder than they had expected (Tulman & Fawcett, 2003a). Recommendations from the Tulman and Fawcett study include interventions that result in a reduction in anxiety and depression during pregnancy and postpartum, utilizing screening scales for depression, and counseling women about having realistic expectations for what can be accomplished during pregnancy and new parenthood.

With these psychosocial needs in mind, the selected pilot materials of the Dear Baby Project presented here target the broad category of emotional and social changes during pregnancy, birth and parenthood. Specifically, the work below explains four related modules. The four modules address: a) the women’s own internalization of their pregnancy and eventual transition to motherhood, b) changes in relationships, communication, and sexuality, c) perinatal anxiety and depression, and d) parenting philosophies and principles of parenting.

Design Process

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All Dear Baby Project materials are designed using simple, easy-to-understand language with colorful pictures. American patients’ low level of health literacy is a major barrier to high quality health care provision. Recent research indicates that most printed medical

communications are written at a 9th grade or higher reading level, usually lacking interaction and summary components (Hansford & Forsdike, 2013; Shieh & Hosei, 2008). According to the Suitability Assessment of Materials (SAM) tool, materials written at or above a 9th grade reading level are not suitable, while materials at a 6th to 8th grade reading level are adequate and materials at a 5th or lower level are superior (Doak, 1996). It is imperative that prenatal health education materials contain simple and easy-to-understand information because a woman’s level of health literacy not only influences her ability to understand and act on health information, it also affects her ability to care for her children and other family members.

In order to ensure that the Dear Baby Project materials and instructions are easy to read, the work here utilizes an online tool that computes the Kincaid Reading Ease and Kincaid Grade Level for the educational materials (Flesch, 1948; Kincaid, 1975). The Flesch-Kincaid scoring method was first developed in the mid-twentieth century and is now a widely-used and recommended tool for assessing the reading level of health education materials (Shieh & Halstead, 2009). All of the Dear Baby Project educational information sheets are crafted to a 7th grade or easier reading level.

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tool helps to ensure that there is clear communication and that the health education materials are suitable (Shieh & Halstead, 2009).

The Modules

This section briefly outlines the contents of the emotional/social modules of the Dear Baby Project. Each module contains one educational information sheet, instructions and materials for one art activity, and a guided literary activity. Some modules have additional journaling prompts that help initiate journaling.

A. Module  1:  The  Woman’s  Experience  of  Pregnancy  (See  Appendix  A  for   examples)  

1. Educational  component—The  educational  fact  sheet  reviews  the  three   stages  of  emotional  development  during  pregnancy  and  provides  links  

to  online  resources  for  further  reading  or  information.  

2. Art  component—“Polaroids”  of  Then,  Now,  and  Later.  

This  art  activity  prompts  women  to  draw,  collage  or  otherwise  create  

“snapshots”  of  important  people,  places,  and  events  that  are  currently  

important  in  their  life.  The  pictures  are  “framed”  in  Polaroid-­‐type  

frames  and  then  can  be  inserted  into  their  journals.  The  activity  helps  

women  identify  existing  resources  in  their  life,  encourages  reflection  

on  what  is  important,  and  will  later  serve  as  a  chronicle  or  time  

capsule.  

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five  best  memories,  five  people  who  have  been  helpful  to  them  during  

the  pregnancy,  etc.  

4. Journaling  prompt—This  activity  includes  prompts  that  encourage   mothers  to  write  about  what  they  were  like  before  they  were  

pregnant  and  what  they  are  like  now.    

B. Module  2:  Relationships  and  Pregnancy  (See  Appendix  B  for  examples)  

1. Educational  component—The  educational  information  sheet  

addresses  intimate  partner  violence  and  identifies  warnings  signs  of  

an  unhealthy  relationship.  The  sheet  provides  resources  to  contact  for  

women  who  believe  they  may  be  in  an  abusive  relationship.  

2. Art  component—Coupon  book  for  parenting  partner.  

Here,  women  fill  in  and  decorate  a  book  of  10  coupons.  The  completed  

book  can  serve  as  a  gift  to  a  parenting  partner  like  the  baby’s  father  or  

grandmother.  Women  design  the  coupons  to  be  redeemable  for  low-­‐

cost  but  fun  activities  that  they  can  share  with  their  parenting  partner.  

Examples  might  include  a  coupon  for  making  the  partner’s  favorite  

dinner,  or  for  watching  their  favorite  movie  with  them.  

3. Literary  component—This  activity  instructs  women  on  creating  an   acrostic  poem  with  the  word  TOGETHER  to  emphasize  working  

together  (with  husband,  partner,  mother,  etc)  to  make  it  through  

pregnancy  and  to  raise  the  baby.    

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1. Educational  component—The  educational  information  sheet  reviews   the  idea  of  stress  and  depression  during  pregnancy  and  presents  

warning  signs  for  perinatal  anxiety  or  depressive  disorders.  

2. Art  component—This  art  activity  leads  women  in  creating  a   bookmark  or  a  hangtag  that  has  inspiring  phrases  or  calming  

instructions.  Women  may  choose  phrases  that  speak  to  them  and  

decorate  the  bookmarker  with  favorite  icons.  Women  can  carry  the  

bookmarker  as  a  totem  or  use  it  to  encourage  calming  or  

decompressing  thoughts  when  they  are  feeling  stressed.  

3. Literary  component—The  literary  exercise  asks  women  to  think   about  stressors  in  their  life  and  to  identify  things  they  can  do  to  

alleviate  the  stress.  The  women  are  also  encouraged  to  think  about  

resources  (people,  books,  etc.)  they  can  use  to  address  issues  of  

concern.  

D. Module  4:  Parenting  Philosophies  and  Identifying  Principles  of  Parenting   (See  Appendix  D  for  examples)  

1. Educational  component—The  educational  information  sheet  

describes  the  concept  of  parenting  philosophies  and  outlines  

important  components  of  parenting  philosophies  and  styles.  

2. Art  component—Favorite  traits  sun-­‐catcher  

With  this  activity,  women  create  a  cheerful  sun  that  can  be  hung  as  a  

sun-­‐catcher  or  as  a  mobile.  On  the  sun’s  rays,  women  use  rubber  

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children  (e.g.  “Courage”,  “Humor”,  “Integrity”,  etc).  This  project  can  

serve  as  a  decoration  in  the  baby’s  nursery  and  requires  the  mother  to  

think  about  what  qualities  she  would  like  to  teach  her  child.  

3. Literary  component—The  literary  exercise  presents  a  framework  that   women  can  fill  in  to  create  their  own  personal  parenting  philosophy.  

Next Steps

This paper proposed the concept of the Dear Baby Project and presented examples of modules related to one of the six core topics to be included in the kit. Future design will include related modules for each of the other five key subject areas. After creating modules for the other units, the next step is to implement a pilot test by distributing a number of kits to various prenatal care providers. Ideally, the implementation will include a pre- and post-test or survey to patients receiving the kits, providing feedback essential to refining the project. The surveys will also ask women about their satisfaction with the kit and ask about feelings of preparedness for childbirth and parenthood. Clinicians will complete a separate survey in order to generate feedback about their perspective of using the kits and suggestions for additional topics or modules.

Ideas For Adaptation

The Dear Baby Project is highly adaptable. In the future, the project may include specialized modules that clinicians select to order to tailor the kits to each patient’s individual needs. Additional modules beyond the six core topics mentioned above may include:

• Modules specific to teen pregnancy • Add-ons for older siblings to complete • A companion kit for fathers

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• Adaption of the product for women who experience perinatal loss.

• An electronic version of the product with information and activities for the computer,

phone or tablet

A preliminary field test of the product and survey data collected from patients and clinicians will help inform priorities for new modules and formats.

Summary And Conclusions

In summary, a wide body of literature indicates that Americans struggle with access to education and preparation for childbirth and parenting. Prenatal education in the United States is fragmented, expensive, and insufficient for parents’ learning needs. This paper presents the concept for a novel approach to prenatal education. The Dear Baby Project utilizes the documented benefits of journaling and reflection and guides expectant women through fun writing and art activities while providing important pregnancy and parenting information. The Dear Baby Project employs a flexible design that allows clinicians to select relevant educational units and to provide a custom tailored learning tool for their patients. The design of the Dear Baby Project minimizes or eliminates many of the common barriers to utilizing prenatal and childbirth education:

• Materials  are  carefully  designed  with  pictures  and  simple,  easy-­‐to-­‐read  language;  

• Women  can  complete  the  project  over  time,  at  their  convenience,  in  whichever  

setting  they  choose;  

• The  activities  in  the  kit  draw  on  each  woman’s  personal  experiences,  making  the  

process  more  relevant  and  fun;  

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• The  reflective  process  and  the  educational  topics  included  in  the  kit  target  the  

affective  and  emotional  aspects  of  pregnancy  that  are  often  missed  in  traditional  

childbirth  classes.  

This paper presented the pilot materials for four related project modules approaching emotional and relationship changes during pregnancy. Future work will include the

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References

Billingham, K. (2011). Preparing for parenthood: The role of antenatal education. Community Practitioner, 84(5), 36-38.

http://www.ingentaconnect.com/content/cp/cp/2011/00000084/00000005/art00016

Breustedt, S., & Puckering, C. (2013). A qualitative evaluation of women's experiences of the mellow bumps antenatal intervention. British Journal of Midwifery, 21(3), 187-194.

http://www.britishjournalofmidwifery.com/cgi-bin/go.pl/library/article.html?uid=97377;article=BJM_21_3_187

Candib, L. M. (2010). The elements of the woman-centered relationship. In S. G. Shields, & L. M. Candib (Eds.), Woman-centered care in pregnancy and childbirth (First ed., pp. 387). Oxford, United Kingdom: Radcliffe Publishing Ltd.

Côté-Arsenault, D. (2007). Threat appraisal, coping, and emotions across pregnancy subsequent to perinatal loss. Nursing Research, 56(2), 108-116. doi:

10.1097/01.NNR.0000263970.08878.87

Demecs, I., Pappne, Fenwick, J., & Gamble, J. (2011). Women's experiences of attending a creative arts program during their pregnancy. Women & Birth, 24(3), 112-121. doi:10.1016/j.wombi.2010.08.004

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Flesch, R. (1948). A new readability yardstick. Journal of Applied Psychology, 32(3), 221-233. doi:10.1037/h0057532

Gager, C. T., McLanahan, S. S., & Glei, D. A. (2002). Preparing for parenthood: Who's ready, who's not? In N. Halfton, K. T. McLearn & M. A. Schuster (Eds.), Child rearing in America. Challenges facing parents with young children. (pp. 50). New York, NY: The Press Syndicate of the University of Cambridge.

Hansford, J., & Forsdike, J. (2013). Learning about having a baby in easy English. Practising Midwife, 16(6), 26-27.

http://www.ingentaconnect.com/content/mesl/tpm/2013/00000016/00000006/art00008

Hanson, L., VandeVusse, L., Roberts, J., & Forristal, A. (2009). A critical appraisal of guidelines for antenatal care: Components of care and priorities in prenatal education. Journal of Midwifery & Women's Health, 54(6), 458-468. doi:10.1016/j.jmwh.2009.08.002

Kincaid, J. P. (1975). Derivation of new readability formulas (automated readability index, fog count and flesch reading ease formula) for navy enlisted personnel. (Naval Technical Training Command, Millington,TN.Research Branch.). Springfield, VA: National Technical Information Service.

Lane, M. R. (2006). Arts in health care: A new paradigm for holistic nursing practice. Journal of Holistic Nursing, 24(1), 70-75. doi: 10.1177/0898010105282465

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attendance with breastfeeding initiation. Maternal & Child Health Journal, 7(2), 87. doi: 10.1023/A:1023812826136

Mills, C., Knuiman, M., Rosenberg, M., Wood, L., & Ferguson, R. (2013). Are the arts an effective setting for promoting health messages? Perspectives in Public Health, 133(2), 116-121. doi:10.1177/1757913911419895

Murphy-Black, T. (1993). Antenatal education. In J. Alexander, V. Levy & S. Roch (Eds.), Antenatal care: A research-based approach (pp. 88). Toronto: University of Toronto Press.

Nolan, M. (2005). Childbirth and parenting education: What the research says and why we might ignore it. In M. L. Nolan, & J. Foster (Eds.), Birth and parenting skills: New directions in antenatal education (pp. 1). Edinburgh: Elsevier/Churchill Livingstone.

Nolan, M., & Foster, J. (2005). Best practice in antenatal education. In M. Nolan, & J. Foster (Eds.), Birth and parenting skills: New directions in antenatal education (pp. 103). Edinburgh: Elsevier/Churchill Livingstone.

Novick, G. (2009). Women's experience of prenatal care: An integrative review. Journal of Midwifery & Women's Health, 54(3), 226. doi:10.1016/j.jmwh.2009.02.003

Perry, C., Thurston, M., & Osborn, T. (2008). Time for me: The arts as therapy in postnatal depression. Complementary Therapies in Clinical Practice, 14(1), 38-45. doi:

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Phillippi, J. C., & Roman, M. W. (2013). The motivation-facilitation theory of prenatal care access. Journal of Midwifery & Women's Health, 58(5), 509-515.

doi:10.1111/jmwh.12041

Porter, E., Kidd, G., Murray, N., Uytman, C., Spink, A., & Anderson, B. (2012). Developing the pregnancy support pack for people who have a learning disability. British Journal of Learning Disabilities, 40(4), 310-317. doi:10.1111/j.1468-3156.2011.00713.x

Renkert, S., & Nutbeam, D. (2001). Opportunities to improve maternal health literacy through antenatal education: An exploratory study. Health Promotion International, 16(4), 381-388. doi: 10.1093/heapro/16.4.381

Roberts, S., & Pies, C. (2011). Complex calculations: How drug use during pregnancy becomes a barrier to prenatal care. Maternal & Child Health Journal, 15(3), 333-341.

doi:10.1007/s10995-010-0594-7

Shieh, C., & Halstead, J. A. (2009). Understanding the impact of health literacy on women's health. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(5), 601-612. doi:10.1111/j.1552-6909.2009.01059.x

Shieh, C., & Hosei, B. (2008). Printed health information materials: Evaluation of readability and suitability. Journal of Community Health Nursing, 25(2), 73-90. doi:

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Slusser, W. M., & Lange, L. (2002). Breastfeeding in the united states today: Are families prepared? In N. Halfon (Ed.), Child rearing in america: Challenges facing parents with young children (pp. 191). New York: Cambridge University Press.

Staricoff, R. L. (2006). Arts in health: The value of evaluation. Journal of the Royal Society for the Promotion of Health, 126(3), 116-120. doi: 10.1177/1466424006064300

Tighe, S. M. (2010). An exploration of the attitudes of attenders and non-attenders towards antenatal education. Midwifery, 26(3), 294-303. doi:10.1016/j.midw.2008.06.005

Tulman, L., & Fawcett, J. (2003a). Looking back at childbearing: Women's expectations and recommendations. Women's health during and after pregnancy: A theory-based study of adaptation to change (pp. 135). New York: Springer Pub. Co.

Tulman, L., & Fawcett, J. (2003b). Motherhood, family relationships, and functional status. Women's health during and after pregnancy: A theory-based study of adaptation to change

(pp. 102). New York: Springer Pub. Co.

U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Retrieved from

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Appendix A Materials for Module 1

The materials below include the educational information sheet, literary activity, and art activity instructions. When printed, the educational information sheet fills a single sheet of paper.

Thinking About Your Pregnancy: What Does It Mean To You?

Purpose: This sheet will tell you about common emotional stages in

pregnancy.

How do you feel about this pregnancy? What are your goals for the next year? Five

years? How does the baby fit in to those plans? Pregnancy is a normal and healthy

process for most women. However, pregnancy comes with many changing

emotions. Women usually go through three emotional stages during their

pregnancy.

STAGE  1:  Accepting  Pregnancy—You  are  pregnant!  

You  might  feel  excited  about  being  pregnant.  You  might  also  feel  nervous  or   conflicted.  By  the  end  of  this  stage  you  will  be  aware  that  you  are  pregnant.   STAGE  2:  Realizing  there  are  two  of  you—You  are  going  to  have  a  baby!    

During  this  stage  you  will  begin  to  see  your  baby  as  a  unique  individual.  Your  baby   is  a  separate  person  growing  inside  of  your  body.  You  will  feel  an  increased  

responsibility.  You  will  probably  have  a  lot  of  questions.  By  the  end  of  this  stage   you  will  realize  you  are  going  to  have  a  baby.  

STAGE  3:  Preparing  for  birth  and  parenting—You  are  going  to  be  a  mother!   During  this  stage  it  will  sink  in  that  you  will  soon  be  a  mother.  This  may  cause   anxiety  or  fear.  On  the  other  hand,  this  time  can  be  very  exciting.  You  will  wonder   what  your  baby  will  look  like  and  what  the  baby  will  be  like.  By  the  end  of  this   stage  you  will  realize  that  you  will  be  a  parent.  

(24)

Want to learn more? Here are some online resources that are

helpful:

• National  Childbirth  Trust:  Emotions  during  pregnancy  

http://www.nct.org.uk/pregnancy/emotions-­‐during-­‐pregnancy#Normal    

• Our  Bodies  Ourselves  http://www.ourbodiesourselves.org/    

• Childbirth  Connection  http://www.childbirthconnection.org/  

Listing Activities To Get You Started Writing About Your

Pregnancy

5 things I have learned during this pregnancy:

5 best days in my life or best memories:

3 things about myself that I have improved or that I am working on

improving:

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(27)

Picturing this Pregnancy: An Art Activity

The next two pages have pictures of empty photograph frames. If your

baby could see the outside world right now, what would he or she see?

What important things have happened this year before baby is born? Fill

in the blank photograph frames with pictures of important people, places

or things in your life. You can use a pen, markers or pencil to draw the

pictures. If you don’t want to draw, you can use scissors and a glue stick

to cut and paste pictures from magazines. Or, you could take pictures

with your phone or camera and print them out. Glue or tape the pictures

to the photograph frames. Make sure you label your photograph frames

so your baby can one day look back and see what you created.

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(29)

Appendix B Materials for Module 2

The materials below include the educational information sheet, literary activity and art activity instructions. When printed, the educational information sheet fills a single sheet of paper.

In It Together: Family, Partners, and You

Purpose: This paper will tell you about feeling safe while you are

pregnant.

Has being pregnant changed how you get along with other people? How do you

think your family will change when you are a mother? Some women who are

pregnant feel supported and loved. Not all pregnant women feel safe, though.

Some pregnant women are victims of violence. Violence is not just a physical

thing. The chart below talks about different ways families get along. Some of the

ways are healthy; others are not. What are your family relationships like? Look at

the chart below to find out.

Signs  of  Healthy  or  Unhealthy  Family  Relationships   Healthy  Signs   Unhealthy  Signs  

Respect   Jealousy  

Safety   Controlling    

Feeling  loved   Unrealistic  expectations  

Being  open  to  talk  about  feelings   Blaming  others  for  problems  or  feelings  

Enjoy  spending  time  together   Explosive    

Listen  to  each  other   Feeling  unstable  

Have  hopes  and  dreams   Verbal  abuse  

Free  from  drug  or  alcohol  abuse   Sexual  assault  or  forceful  sex  

Stable  and  reliable   Acts  or  threats  of  violence  

(30)

Want to learn more? Here are some online resources that you can

use:

• UNC  Hospital’s  Beacon  Child  and  Family  Program.  Information  on  domestic  

violence.  http://www.med.unc.edu/beacon/forms-­‐of-­‐violence/domestic/domestic    

• National-­‐State  Coalition  Against  Domestic  Violence.  

http://www.ncadv.org/resources/StateCoalitionList.php    

Relationships and Emotions: Make An Acrostic Poem

Being pregnant can be hard and being a parent can be even harder!

Sometimes you may feel like you are doing it alone. But, there are

people who will help you through. Taking help from family or your

friend makes pregnancy easier. Help from family or a friend can also be

good for your baby. Think of someone who has helped you so far or will

help you in the future. It could be your partner, your mother or

grandmother, your best friend or a neighbor.

(31)

Relationships and Emotions: Make An Acrostic Poem

Here is an example of an acrostic poem that a mother made to describe

her own mother.

A person who has helped me during my pregnancy

is_______________________. Here is a poem to describe that person:

T

O

G

E

T

H

E

(32)
(33)

Relationships and this Pregnancy: How to Make a Personalized

Coupon Book

Purpose: This paper will tell you how to make a coupon book for

someone who has helped you during your pregnancy

In your packet you will find a blank coupon book. You can use your art supplies to

fill out the coupon book. It will make a nice gift for someone who has helped you

during this pregnancy.

Using markers, pens, stamps, stickers and other materials decorate the front of your

coupon book. Below is an example of a decorated book. It has simple stamped and

handwritten letters. It says “Coupons for my partner in crime”.

Figure  1  An  example  of  how  you  might  label  your  coupon  book.

 

After you have decorated the outside of your coupon book, make a list of coupon

ideas. The ideas can be for activities or things that do not require money. They can

be simple.

Here is a list of some ideas:

(34)

Visiting  a  favorite  museum  

A  back  or  foot  rub  

Enjoying  ice  cream  sundaes  together  

Going  to  a  concert  

Taking  a  picnic  

Making  the  person’s  favorite  dinner  

Look  up  the  schedule  for  the  moon  and  admire  a  full  moon  

Breakfast  in  bed  

Once you have a list of some “gifts” that you would like to put on your coupon

book, decorate each page of the book. The picture below shows what a coupon

could look like.

Figure  2  An  example  of  what  one  coupon  looks  like.  The  coupon  says  “Blast  from  the  past:  Let’s  have  a  brownie   sundae  and  look  through  our  old  photo  albums  together.”

 

(35)

Appendix C Materials for Module 3

The materials below include the educational information sheet, literary activity and art activity instructions. When printed, the educational information sheet fills a single sheet of paper.

Anxiety and Depression During Pregnancy

Purpose: This sheet will tell you about depression and anxiety during

pregnancy

Feeling depressed when you are pregnant is more common than many people think.

About 1 out of every 5 or 6 mothers deals with anxiety or depression while she is

pregnant. Some women do not realize they are depressed when they are pregnant.

Being depressed while pregnant may be different than depression during other

times of life.

  Signs  Of  Depression  During  Pregnancy  

Strong  anxiety  or  fear—more  than  just  a  little  bit  worried   Feeling  sad  and/or  crying  a  lot  

Feeling  worthless  or  like  you  will  not  be  a  good  mother   Wanting  to  be  dead  or  thinking  of  killing  yourself  

Frequent  headaches,  fast  beating  heart,  or  feeling  like  you  cannot  breathe   Not  being  able  to  sleep  even  when  you  are  very  tired,  or  sleeping  too  much   Feeling  overwhelmed  or  hopeless  

Trouble  making  decisions   Very  low  energy  

It is normal to have some worries when you are pregnant. Writing in your journal

can help. You can also talk to someone you trust. If your worries keep you from

enjoying your life, you can talk to your healthcare provider. If you feel anxious or

depressed it is important you seek help. With help you can feel better. Whatever

you are feeling, you are not alone. If you struggle with depression, you are not to

blame.

(36)

• UNC’s  Center  for  Women’s  Mood  Disorders  

http://www.med.unc.edu/psych/wmd/mood-­‐disorders/perinatal    

• Postpartum  Support  International  http://www.postpartum.net/    

• Advice  for  finding  a  competent,  caring  therapist  (via  Our  Bodies  Ourselves)  

http://www.ourbodiesourselves.org/book/excerpt.asp?id=11    

Working Through Your Worries: Let’s Make A Plan

It is natural to feel tired, irritable or worried during pregnancy. One way to help

work through your worries is to write about them and make a plan.

1.

Use  the  space  below  to  write  down  a  concern  or  worry  that  you  have  

had  during  this  pregnancy.  

2.

List  some  people  who  might  be  able  to  help  you  figure  out  a  solution.  

3.

List  some  ideas  you  have  for  how  to  work  through  the  problem.  

Here is an example of a concern that mother had and her ideas for addressing that

worry.

One thing I have been concerned about is

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Some people who might be able to help me are

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Some ideas that might help with addressing my worry are

(37)

Now that you have seen an example, use the next page to write about your

concerns. If you need more room, you can use some journal paper to write down

more of your thoughts.

Working Through Your Worries: Let’s Make A Plan, Continued

One thing I have been concerned about is

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Some people who might be able to help me are

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Some ideas that might help with addressing my worry are

(38)
(39)

Keeping Calm and Carrying On: Making an Inspirational

Bookmarker

Purpose:

This paper will tell you how to make a bookmark that will help calm you

when you’re feeling overwhelmed.

In your packet you will find two blank bookmarkers. You can decorate the bookmarkers and carry them with you.

1. Use markers, pens, stamps and other materials to make a relaxing or peaceful design on the front one of the blank bookmarkers.

2.Next, think of a calming phrase. You could use phrases like “at peace” or “onward.” Using a marker, pen or alphabet stamps, write the phrase on the front of one of the bookmarkers.

 

(40)

3. Now, make a list of a few things you can do when you feel overwhelmed. You could take a walk, call a friend, clean the house, listen to some music, or things like that. You will write or stamp this list on the back of your bookmarker.

 

Figure  4  The  back  of  the  bookmarker  has  a  list  of  things  to  do  when  feeling  anxious.  

4. You can decorate your second bookmarker with a different design. You can write or stamp a quote that inspires you.

You can use your bookmarkers while reading. Or, you could carry them in your bag and look over them when you’re feeling anxious.

(41)

Appendix D Materials for Module 4

The materials below include the educational information sheet, literary activity and art activity instructions. When printed, the educational information sheet fills a single sheet of paper.

Parenting Philosophies: What Kind of Parent Will You Be?

Purpose: This sheet will tell you about different types of parenting.

What plans do you have for yourself after your baby is born? Many moms have a

certain way they want to raise their baby. A parenting philosophy is a set of ideas

about the way a person should raise her child. An example of a parenting

philosophy is “Attachment Parenting”. With attachment parenting, parents think

the bond formed between parent and child has important life-long meaning. The

parents try to be sensitive and available to their children. The chart below lists

some parts that make up different parenting styles. Often parents combine styles.

You can make a unique parenting style. You can pick and choose the parts that are

important to you.

Different  Parts  That  Make  Up  Parenting  Styles  

Decision  Making:    Who  makes  the  decisions  in  the  family?  Should  the  child  make  any   decisions?  

Control:  Does  the  parent  make  the  rules  and  demands?  Does  the  parent  explain  the   rules  to  the  child?  

Involvement:  Is  the  parent  involved  in  the  child’s  life?  How  much  attention  does  the   child  get?  Is  the  child  the  center  of  attention  in  the  family?  

Acceptance:  Is  the  parent  warm  and  responsive?  Does  the  parent  like  to  give  the  child   whatever  he  or  she  wants?  

Whose  Job  Is  It?:  Is  the  work  shared  equally  between  all  adults?  Whose  job  is  it  to   raise  the  child?  

Discipline:  When  your  child  does  not  follow  the  rules,  what  will  you  do?  

(42)

Want to learn more? Here are some online resources that are

helpful:

• Attachment  Parenting  http://www.askdrsears.com/topics/parenting/attachment-­‐

parenting    

• Our  Bodies  Ourselves  http://www.ourbodiesourselves.org/    

• Mothers  and  Caregivers  Online  Resources  

http://www.now.org/issues/mothers/resources.html    

What Kind of Parent Do You Want to Be? Creating a Parenting

Philosophy.

Purpose: This sheet will help you to design a personal parenting

philosophy.

Think about the people who raised you when you were child. What kinds of things

did they do to help you grow? What kinds of things do you wish they had done?

Now think about your baby. What kinds of traditions do you want to pass on?

What kind of values do you want your baby to have? This sheet will help you write

about the kind parent you want to be.

(43)

What Kind of Parent Do You Want to Be? Creating a Parenting

Philosophy.

In our family, the main values we try to live by are:

_________________________________________________________________

__________________________________________________________________

_________________________________________________________________

__________________________________________________________________

__________________________________________________________________

As a mother, I would like to teach my baby ____________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

My parenting philosophy means that every day I will remember this about

(44)
(45)

Parenting Your Baby: Make A Cheerful Sun-catcher

Purpose: This paper will tell you how to make a cheerful sun-catcher

for your baby.

When you are finished with this art project your sun-catcher will look like this.

Figure  5:  You  will  make  a  sun-­catcher  like  this  one.  

To start, get the plastic bag with the sun-catcher supplies in it. You will need the

yellow and the orange sun papers. You will also need the two pieces of sticky

plastic papers. You will need your alphabet stamps, inkpad, and your scissors, too.

(46)

Figure  6  You  will  stamp  words  on  your  yellow  sun  paper.

 

In the picture above, I used:

Courage  

Humor  

Determination  

Empathy  

Integrity  

Gusto  

 

2.

Use  the  alphabet  stamps  and  your  inkpad  to  stamp  the  words  on  your  

yellow  sun  paper.  If  you  do  not  want  to  stamp  the  words,  you  can  write  

them  in  pen  or  marker.

 

(47)

Figure  7  Plastic  sticky  paper  has  a  shiny  side  and  a  sticky  side  that  is  covered  by  the  white  waxy  paper.

 

Peel  off  the  white  waxy  paper  from  the  back  of  the  sticky  paper.  Put  the  

paper  on  your  table  so  the  sticky  side  is  toward  the  ceiling  and  the  shiny  

side  is  touching  the  table.  Put  your  sun  papers  on  the  sticky  paper.  Put  the  

yellow  sun  with  the  words  point  down  toward  the  paper.  Next  put  the  

orange  paper  on  top  of  the  yellow.  It  will  look  like  the  picture  below.  

(48)

4.

Now  you  will  make  the  sun  face.  First  put  down  two  black  circles  inside  of  

the  sun’s  center.  The  black  circles  are  the  sun’s  eyes.  Then  put  down  two  

pink  tissue  paper  circles  on  the  sticky  paper  to  make  the  sun’s  cheeks.  Then  

you  put  the  black  string  from  cheek  to  cheek  to  make  the  sun’s  smile.  Your  

sun  will  look  the  like  the  picture  below.  

Figure  9  Make  the  sun's  face  in  the  center  of  the  circle.

 

(49)

Figure  10  The  sun's  face  is  covered  with  tissue  paper  bits.

 

6.

Now  you  will  use  the  second  piece  of  sticky  paper.  Peel  off  the  white  waxy  

paper  from  the  plastic  sticky  paper.  Cover  your  sun  with  the  sticky  paper  

so  that  the  sticky  paper  points  towards  the  table  and  the  shiny  side  points  

toward  the  ceiling.  The  sun  will  be  sandwiched  between  the  two  sticky  

papers.  Smooth  out  your  project.  

 

(50)

7.

Next,  use  your  scissors  to  cut  off  the  extra  plastic  sticky  paper  around  the  

sun.  When  you  are  finished  you  will  have  your  sun-­‐catcher  ready  to  be  

used.  You  can  tape  it  into  a  window  or  you  can  punch  a  hole  in  the  top  and  

hang  it  from  the  ceiling.  The  sun  will  shine  through  the  tissue  paper  and  

your  baby  can  see  the  sun’s  smiling  face.  

(51)

Figure

Figure	
  1	
  An	
  example	
  of	
  how	
  you	
  might	
  label	
  your	
  coupon	
  book
Figure	
  2	
  An	
  example	
  of	
  what	
  one	
  coupon	
  looks	
  like.	
  The	
  coupon	
  says	
  “Blast	
  from	
  the	
  past:	
  Let’s	
  have	
  a	
  brownie	
   sundae	
  and	
  look	
  through	
  our	
  old	
  photo	
  albums	
  together.”
Figure	
  3	
  This	
  bookmarker	
  uses	
  the	
  phrase	
  "at	
  peace".	
  
Figure	
  4	
  The	
  back	
  of	
  the	
  bookmarker	
  has	
  a	
  list	
  of	
  things	
  to	
  do	
  when	
  feeling	
  anxious.	
   	
  
+7

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